Prescription Opioids, Time to Rethink How We Assess Risk

While the opioid epidemic was officially declared a public health emergency in 2017, the USA has grappled with this problem for much longer. After 2017, the response to the crisis came at every level, from individual practices and healthcare establishments to state and national organizations and the government. The result was an influx of policies and laws aimed at reversing the epidemic, primarily by restricting the initial prescription of opioids. The CDC report from 2019 noted a decrease in the prescribing rates of opioids; however, opioid-related deaths have not followed suit. This discrepancy is without a clear explanation but raises numerous issues.

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Cigna: Uniting Medical, Drug And Mental Health Saves $850 Per Enrollee

Cigna said efforts to combine medical, pharmacy and behavioral benefits saves more than “$850 per customer,” according to the insurer’s internal analysis.

Cigna, which owns the large pharmacy benefit manager (PBM) Express Scripts, released its fourth annual “value of integration” study documenting various savings for employer clients that have a “connected set of medical, pharmacy, and behavioral benefits.” The insurer looked at more than 2.3 million customer claims during a two-year period.

Though an internal report that would seem to favor a developing Cigna strategy, the analysis captures a broader effort by the health insurance industry to integrate more than just medical benefits into offerings they sell to employers and government clients.

Health insurers see a value-based approach that better coordinates care for the “whole person” as a way to improve health outcomes and ultimately save money. That contrasts with fee-for-service medicine that pays doctors and hospitals based on volume of care delivered.

The full Forbes article can be viewed at this link.  

Long Term Care: Navigating The Decade Ahead

We’re days away from entering what the World Health Organization proclaimed to be “the Decade of Healthy Ageing.” Health systems around the world, however, are woefully underequipped to provide the care that healthy aging requires.

From 2020 to 2030, the pressure will be on for national governments, policymakers, and healthcare providers to redress the scarcity of resources available to the elderly and the people who care for them. High on any country’s list of priorities should be the research, development, and funding of robust long term care systems. Within thirty years, the number of older adults in need of long term care is expected to reach 277 million globally. Of these, millions—27 million, to be exact—will be living in the United States. 

To build long term care systems with the sole purpose of purveying end of life supports and services is not enough—not nearly. For these systems to be accessible, affordable, and equitable to all, they must discard a notion of health overdetermined by illness and treatment in favor of one befitting the full complexity of the person.

The full article can be viewed at this link.  

On the Digital Health Conundrum (Part I)

For a decade, digital health has been the supposed savior of the healthcare system, coming to drive healthcare into a data-first, low-cost industry worthy of the 21st century. Investors have poured over $30b into digital health since 2011 but what material change can we point to in health care costs or the experience of the average patient? Are there companies that qualify as major disruptors? To me, the answer is no. I call this the Digital Health Conundrum.

The full Medium article can be viewed at this link.  

Resolving Tension Between Cost-Effectiveness Analysis And Patient Centricity

There appears to be an inherent tension between cost-effectiveness analysis that informs allocative efficiency at the population level, and patient centricity. Here, patient centricity can be defined as incorporation of patient-centric outcomes in value calculations and inclusion of patient input in clinical and economic decisions.

Ideally, precision medicine resolves this tension, as by definition it’s patient-centric, and when done right, cost-effective. But, there’s still a long way to go before precision medicine’s promise becomes widespread reality.

Through intermediaries, such as payers, cost-effectiveness analysis informs treatment choices made by physicians and patients. For patients and their healthcare providers, issues can arise when reimbursement protocols (e.g., formularies) derived from population-based cost-effectiveness analysis impact (often limit) the choices patients and physicians can make.

The full Forbes article can be viewed at this link.  

Humana: Value-Based Care Report

Physicians in value-based agreements with Humana are evolving and seeing results. This report details three key areas of data: prevention, outcomes and cost and payments for Humana Medicare Advantage individual members assigned to primary care physicians in value-based agreements.

Humana shares these results annually to spotlight physicians’ progress and to highlight how the company supports them helping their patients achieve their best health.

The full report can be viewed at this link.  

What Fintech Can Do For Healthcare

In most countries, the process of paying for health coverage is not just costly, but complicated, stressful, and time consuming. It also prohibits people from accessing care.

If exorbitant prescription drug prices and out of pocket expenses were not already enough, healthcare consumers must also navigate payment systems known for their obscurity and susceptibility to error. These systems not only overwhelm current users, but also discourages new ones from finding the coverage that is right for them.

The relationship between a healthcare consumer and their healthcare financing should not—and does not—have to be so fraught. As health services becoming increasingly digital, more opportunities open up for companies to stage data driven interventions that can modernize, and hopefully revitalize, our fragmented healthcare networks.

Such is the aim of fintech, or financial technology, that brings new and improved digital financial service models into the healthcare space. Fintech companies are leveraging powerful innovations blockchain, artificial intelligence, and machine learning to eliminate the inefficiencies and knowledge gaps endemic to most healthcare payment plans. With few exceptions, what unites them all is their ability to streamline the flow of information and money between patients and providers—and in doing so, save everyone involved precious time and effort.

The full Forbes article can be viewed at this link.  

Record-Breaking FDA Approvals Mean Hope for Patients but Challenges for Healthcare Access, Delivery and Affordability

Last year, the U.S. Food and Drug Administration (FDA) approved a record-breaking 59 new medicines that will advance healthcare for patients with chronic and rare diseases.

This is great news, because it shows that our scientific understanding of the mechanisms that change the course of disease is leading to pharmaceutical breakthroughs. And the evolution of regulatory requirements like Therapy Breakthrough designation is shortening approval times and getting new treatments to patients faster.

However, this same progress presents significant challenges for the healthcare industry. While recent and anticipated scientific innovation marks much-needed progress for patients, in many cases, the systems designed to promote patient access to these new treatments have not kept pace.

This disparity will undoubtedly impact many areas of healthcare. Payers, distributors and pharmacies will have to address the challenges that come with how a new generation of medicines is covered, reimbursed, distributed and dispensed—in addition to creating the need for effective care strategies that optimize outcomes.

The full Surescripts article can be viewed at this link.  

How patient satisfaction scores are changing medicine

Healthcare organizations have been using patient satisfaction scores since the late 1980s to improve care delivery and calculate physician and staff bonuses, among other purposes. Now, in the shift toward value-based care, such scoring is playing an even greater role in determining physician reimbursement and helping patients choose a physician.

But is it also changing the way physicians practice medicine?

Physicians, frustrated with feelings of powerlessness over how the scores are determined, fear that they give patients too much influence. Experts say the scores are here to stay, and offer suggestions for ways to approach them in the future.

The full Medical Economics article can be viewed at this link.